In this article is presented a field study where participatory design tools and techniques were used in Cambodia to develop ideas for a device that enables children who use prosthetic legs to walk in mud. The study also identifies and describes examples of differentiating circumstances across four categories: human; social, cultural and religious; financial and timeframe; and organizational. The field research illustrates that an important advantage of using participatory design with marginalized people in developing countries is the opportunity to develop empowering outcomes of two types: products that meet the users’ needs as well as psychological empowerment of the participants. It is proposed a pyramid model of empowering outcomes that is based on Zimmerman’s (1995) model of psychological empowerment. Based on integrating this notion of psychological empowerment, it is presented an alternative framework for deploying participatory design in developing countries as it has served in the Cambodia case.